California Common Core Training Version 1.25 CHILD MALTREATMENT IDENTIFICATION, PART II: Sexual Abuse and Exploitation California Common Core Training Version 1.25

Learning Objectives/Overview Present the historical background, legal definitions and dynamics of child sexual abuse; Discuss characteristics of perpetrator, victim, and non-offending caretaker; Identify physical, behavioral, and emotional indicators of child sexual abuse; Examine the dynamics involved in sexual abuse and sexual exploitation; Practice identifying child sexual abuse when allegations occur.

History: Current U. S. “Discovery” Cycle Some publications for specific disciplines began to appear in the early 1980’s. “Stranger-Danger” was believed to be the most common form of child sexual molestation. During this same time period, the McMartin/Manhattan Beach, Country Walk, and Jordon, MN multiple victim cases involving pre-schoolers were publicized.

History: System Responses Mandatory Reporting Specialized Investigative Units Formed Government Sponsored Trainings Developed Joint Investigations Between CPS & LE Begun Increased Criminalization of Incest Child Advocacy Center Concept Begins State and Federal Laws Enhanced or Developed Research on Child Sexual Abuse Begins Child Interviewing Protocols Developed

And Now For You… Possible personal difficulties in working cases with sexual aspects: Emotional reactions are expected and normal Matters dealing with sexualized behaviors are very personal and value laden Sexual abuse victimization history Parenthood Personal feelings concerning sexuality, sexually motivated behaviors, and children and sexuality

Questions For You… Where and under what conditions you were taught or learned about sex, sexuality, and what is appropriate or inappropriate sexual behaviors? Who informed you? What were your emotions and what caused them? Girls were told by? Boys were told by? Cultural Differences?

Question for you. . . What are some ways that your own views of sexuality may impact your handling of situations involving the sexual abuse of children?

Exercise: Body Part Identification All terms or phrases are considered Clinical/ “proper” Slang/ Euphemisms Cultural Write on post-its and place on appropriate body part Most post-its up wins for the team

General Definition Components Sexual contact that is accomplished by threats or threat of force, regardless of the ages of participants; All sexual contact between an adult and a child regardless of whether there is deception or the child understands the sexual nature of the activity; Sexual contact between a teenager and a younger child can also be abusive if there is a significant disparity in age, development, or size, rendering the child victim incapable of giving informed consent. (Ryan, 1991) See California Penal Code 11165.1(a,b,c,)

Continuum of Behaviors Non-contact sexual acts such as exposure, voyeurism, showing or producing pornography, masturbation or other sexual acts in front of the child; Touching of the sexual or erogenous zones or touching designed for the sexual gratification of the perpetrator or for the furtherance of sexual activity; Penetration of vagina, anus, mouth

Legal Definitions for Sexual Assault and Sexual Exploitation California Welfare & Institutions Code (WIC) Section 300(d) California Penal Code (PC) Sections 11164-11165

Informed Consent The dimensions of informed consent: 1. Know what is being requested 2. Have a thorough understanding of the consequences of the behavior 3. Have an equal power base in the relationship 4. Be able to say no without repercussions Abel, G.G., Becker, J.V., & Cunningham-Rathner. (1984). Complications, consent, and cognitions in sex between children and adults. International Journal of Law and Psychiatry, 7, 89-103.

Prevalence 9.7% of maltreatment reports involve sexual abuse (2004) % of American females who are sexually abused or exploited in some manner before 18: 1 in 3-4 % of American males who are sexually abused or exploited in some manner before 18: 1 in 7-10 (underreporting a major issue) 90-95% of sexual abuse is perpetrated by someone the child knows. * Child abuse reporting systems and clinical programs tend to over represent intrafamilial cases. Based on general population surveys, abuse by parent figures constitutes between 6 and 16% of all cases, and abuse by any relative comprises more than 1/3 of cases.

Prevalence The challenge of the numbers… All are estimates and have limitations: Different studies use different definitions. Child abuse reporting and clinical programs tend to over-represent intrafamilial cases. Cases reported by official agencies meet a particular standard, many cases never get reported so these data sources underestimate the number of victims. Numbers are reported for different time periods.

Key Questions: Child Welfare Does the allegation involve intra-familial abuse? Is the child safe? Did abuse occur, per WIC Section 300? * Also refer to Trainee Content re: When Consensual Sexual Intercourse is Deemed Child Abuse in California Is the caregiver able/willing to protect the child? Is there a viable safety plan to allow the child to stay in the home?

Key Questions: Law Enforcement Is the child safe? Did a crime occur, per the Penal Code? Is the alleged perpetrator safe in the community?

Sexual Behaviors Research has also demonstrated a consistent relationship between sexual abuse and sexual behaviors in pre-adolescent children. HOWEVER, a broad range of sexual behaviors has been observed in children who do not have a history of sexual abuse. Important to be aware of what is normal sexual development, including related behaviors, interactions, and feelings for the growing child!

Exercise: Sexual Behavior Cards What do you think is: NATURAL/HEALTHY, PROBLEMATIC/ OF CONCERN, or ABUSIVE/ SEEK PROFESSIONAL HELP?

When do sexual behaviors need to be addressed? Is the behavior putting the child at risk for physical harm, disease or exploitation? Is the behavior interfering with the child’s development, learning, social or family relationships? Is the behavior violating a rule? Is the behavior causing the child to feel confused, embarrassed, or bad? Is the behavior causing others to feel uncomfortable? Is the behavior abusive because it involves lack of informed consent, some type of coercion or lack of equality?

Importance of Context Observers of children’s normal sexual behaviors note: It is curious in nature; Children involved in normal sex play are generally of similar age, size, and developmental status; Children participate on a voluntary basis; It is balanced by curiosity about other aspects of their lives; Does not usually leave children with deep feelings of anger, shame, fear, or anxiety; The affect of children regarding their sexual behavior is generally light-hearted and spontaneous.

Adolescent Sexual Experience Quiz What do you know? Are these statements TRUE or FALSE?

Child Sexual Abuse in a Cultural Context Acceptance and manifestation of sex and sexuality within cultures Appropriate and inappropriate sexual behaviors and participants Sanctions Sexual orientation, gender identification Assignment of responsibility and/or “blame”

Cultural Aspects of Shame in Child Sexual Abuse Responsibility for the abuse Failure to protect Fate Damaged goods Virginity Predictions of a shameful future Promiscuity, homosexuality, sexual offending Re-victimization Layers of shame

Gender & Sexual Orientation Issues Double standard for males and females Sexual orientation

Elements to consider in Identifying Child Sexual Abuse Commonly referred to as “indicators” Four broad areas: Reporting (including aspects of the allegation and disclosure); Physical (including medical indicators); Behavioral (including emotional indicators for the victim); and Familial (including family and caregiver dynamics)

Presence of Indicators ≠ Abuse Remember. . . Presence of Indicators ≠ Abuse

Reporting Elements Credibility of the report (and the reporter) Type and credibility of the child’s disclosure Corroboration of disclosure/report Statements about prior unreported sexual abuse History of CWS involvement

Physical Elements Presence of illness or injury (ies) Report of past illness or injury (ies) Explanation of illness or injury (ies) Developmental abilities of alleged victim Developmental abilities of alleged perpetrator Medical assessment findings

Physical Elements: Medical Assessments When? In all cases in which the most recent episode of abuse/assault occurred within the last 72 hours When penetration is disclosed, regardless of time To assess any injury/pain/physical complaints of the child When the child would benefit from a medical opinion Know your county’s protocols!

Behavioral Elements History of sexually abusive behavior by someone in the home or with access to the child Developmentally or socially inappropriate sexual knowledge and/or sexual behavior by alleged victim Self-protective behavior by alleged victim Indicators of emotional distress by alleged victim Coaching or grooming behaviors

Behavioral Elements: Emotional Distress Trauma-related indicators: Physiological reactivity/Hyperarousal (hypervigilance, panic and startle responses, etc.) Retelling and replaying of trauma and post-traumatic play Intrusive, unwanted images and thoughts and activities intended to reduce or dispel them Sleeping disorders with fear of the dark and nightmares Dissociative behaviors (forgetting the abuse, placing self in dangerous situations related to the abuse, inability to concentrate, etc.)

Behavioral Elements: Emotional Distress Anxiety-related indicators Obsessive cleanliness Self-mutilating or self-stimulating behaviors Changed eating habits (anorexia, overeating, avoiding certain foods)

Behavioral Elements: Emotional Distress Depression-related indicators: Lack of interest in participating in normal physical activities, loss of pleasure in enjoyable activities Social withdrawal and the inability to form or to maintain meaningful peer relations Profound grief in response to losses of innocence, childhood, and trust in oneself, trust in adults Suicide attempts Low self-esteem, poor body image, negative self-perception, distorted sense of one’s own body

Behavioral Elements: Emotional Distress Other indicators: Personality changes Temper tantrums Running away from home Premature participation in sexual relationships Aggressive behaviors Regressive behaviors in young children (thumb sucking or bedwetting) Poor school attendance and performance Somatic complaints Accident proneness and recklessness

Familial Elements Isolation of the child (inhibits reporting and makes child more vulnerable) Coercion/threats made to the child to prevent disclosure Current caregiver’s substance abuse Opportunity for the abuse to occur

Myths and Facts about the Forensic Medical Examination The medical examination will confirm if there was sexual abuse. If sexual abuse occurred, there will be findings. Exams can confirm if a girl is a virgin or not. The examination will likely be traumatic for the child. The exam mimics an adult gynecologic exam. If a child’s pediatrician did an exam, that is sufficient.

Myths and Facts about the Forensic Medical Examination The medical examination will confirm if there was sexual abuse. Myth If sexual abuse occurred, there will be findings. Exams can confirm if a girl is a virgin or not. The examination will likely be traumatic for the child. The exam mimics an adult gynecologic exam. If a child’s pediatrician did an exam, that is sufficient.

A View From The Shadows Johnny’s Story

Sgroi’s Five Stages in CSA Engagement Sexual interaction Secrecy Disclosure Suppression

Summit's Child Sexual Abuse Accommodation Syndrome Secrecy Hopelessness Entrapment and accommodation Delayed, conflicting, and unconvincing disclosure Retraction

in Johnny’s disclosure? How do we see Sgroi’s Stages and Summit’s Child Sexual Abuse Accommodation Syndrome in Johnny’s disclosure?

What Is the Evidence? Child Disclosures of Sexual Abuse Summary of Research Findings: (Olafson & Lederman, 2006) Majority of CSA victims do not disclose their abuse during childhood;

Olafson & Lederman (2006), cont’d 2. When children do disclose sexual abuse during childhood, it is often after long delays. 3. Prior disclosure predicts disclosure during formal interviews. 4. Gradual or incremental disclosure of child sexual abuse occurs in many cases, so that more than one interview may become necessary. 5. Experts disagree about whether children will disclose sexual abuse when they are interviewed. However, when both suspicion bias and substantiation bias are factored out of studies, studies show that 42% to 50% of children do not disclose sexual abuse when asked during formal interviews.

Olafson & Lederman (2006), cont’d 6. School-age children who do disclose are most likely to first tell a caregiver about what happened to them. 7. Children first abused as adolescents are most likely to disclose than are younger children, and they are more likely to confide first in another adolescent than to a caregiver. 8. When children are asked why they did not tell about the sexual abuse, the most common answer is fear. Recantation rates range from 4% to 22%. Lack of maternal or paternal support is a strong predictor of children’s denial of abuse during formal questioning. Many unanswered questions about children’s disclosure patterns remain, and further multivariate research is warranted.

Olafson & Lederman (2006), cont’d Additional factors that affect children’s disclosure of sexual abuse: Abuse by a family member may inhibit disclosure; Dissociative and post-traumatic symptoms may contribute to non-disclosure; Modesty, embarrassment, and stigmatization may contribute to non-disclosure; and

Non-Offending Parent/Caregiver Reactions Reactions you may see: Denial Anger Bargaining Depression Resolution BUT- Change and movement between the reactions can happen and will!

Why don’t moms believe? Anger Disbelief Denial Shame Guilt Self-blame Hurt Betrayal Confusion and doubt Own abuse history Jealousy Sexual inadequacy or rejection Minimization Revenge Financial or other fears Religious concerns Protect perpetrator Hatred Repulsion

Why don’t moms protect? Behaviors can be viewed on a continuum: Knows nothing Has knowledge and does nothing Recognizes potentially abusive behaviors, ineffectual or no protection May “sense” something isn’t right, but doesn’t ask Recognizes potentially abusive behaviors, acts to reduce risk or intervene

Why don’t moms protect? Growing evidence shows when mothers are incapacitated in some way children are more vulnerable to abuse. This may take a variety of forms: Absent due to divorce, sickness, or death; Emotional disturbances, psychologically absent; Their own intimidation, fear, or abuse; Large power imbalance with perpetrator undercuts her ability to be an ally for her children.

Perpetrator Dynamics Rule 1: They don’t look or act the way you’d expect -No profile of offender -Have a public self vs. private self Rule 2: The rules of logic do not apply - Need-based cognitive distortions - They come to believe their own distortions

Perpetrator Continuum Situational: Do not have a true preference for children May molest for a wide variety of reasons More likely to be aroused by adult pornography Frequently molest readily available children that they have easy access to Victims young, vulnerable, accessible, less likely to be believed, easy to manipulate or threaten

Perpetrator Continuum Preferential: Primary sexual orientation is toward children Over represented in the higher SES groups Behavior tends to be scripted, compulsive, and primarily fantasy-driven. More specific sexual preferences as to age, gender, body type Pornography usually focuses on the themes of their sexual preference (children) Refer to Behavioral Analysis of Sex Offenders Handout

TRUTH, LIES, & SEX OFFENDERS

Finklehor’s Four Pre-Conditions to CSA Motivation of the perpetrator to sexually abuse. Internal inhibitors against acting out abuse. External inhibitions against acting out abuse. Resistance of the child to the attempted abuse.

Information Gathering (Tab 3, pages 61 – 63) Goals Methods Training Documentation Child Welfare Information gathering; safety and risk assessment; protective capacity; case management; court proceedings Engagement, empathic, strength-based Social work Written summary Forensic Objective fact-finding for legal proceedings and for all members of MDIT Child: Research-based protocols; Adults: Varies from empathetic to confrontational Specialized Detailed written, Signed statements, audiotape or videotaped Clinical Information gathering for psychosocial assessment & treatment Empathic, strength-based, subjective, unstructured, supportive Brief notes, confidential 55 55

Information Gathering with a Child (Child Welfare Perspective) Who Where (body parts, geographical) What How Documentation Clarification Closure Explanation of next steps 56 56

What is a Forensic Interview? A forensic interview is conducted with the expectation that it will become part of a court proceeding. It is intended for a judicial audience and governed by rules of evidence. Its goal is to obtain facts for a court trial or hearing. The forensic interviewer strives to: maintain a neutral and objective stance, to facilitate the child’s recall of previous events they witnessed or experienced. To ascertain the child’s competence to give accurate and truthful information.

Examples of General Questions Which is better? Do you know why you’re here today? or Tell me why you’re here today. Do you know why we’re talking today? Tell me why we’re talking today.

Avoid These Questions! Leading (The answer to the questions is quite clear in the question itself) Your mother rubs your private parts, doesn’t she? Coercive Statements (Interviewer offers the child something in return for an appropriate response) You can’t go home until you tell me who did this. If you tell me who did this to you, I’ll buy you some ice cream.

Information Gathering: Child Victims (also refers to section on Impact of Abuse) Guilt “Damaged Goods” belief Blurred physical boundaries Sexualized behaviors Ability to say “NO” Difficulty in talking about ‘taboo’ material Embarrassment, shame, anger, fear Location of interview Degree of privacy Rapport with interviewer Previous decision to disclose Questioning style of the interviewer Presence of a witness (supportive or otherwise) Response of other adults to previous disclosures of maltreatment

Information Gathering: Non-Offending Parent Expect denial, disbelief, minimization, projection of blame and possibly hostility toward you; Choose interview location where perpetrator has little or no power; Explore observations, time frames, relationships, mental health issues (depression), use of medications, sexual abuse/activity history; possibility of DV/ emotional abuse, support system, etc.; Prepare for it to take some time before attitude or belief changes.

Information Gathering: Non-Offending Parent Assess dependency issues; drug/alcohol use Assess ability to emotionally support child or children; Anything you tell them, you need to provide in writing; Assess ability to carry through safety plan and investigative requirements (willingness and/or cognitive or logistical ability); Be prepared to allow ventilation time; Always leave the door open for further conversations; Really LISTEN to what their primary concerns are.

Issues With Non-Abused Siblings May be angry with victim for telling (decisional balance) and the consequences of disclosure; May develop negative behaviors or withdrawal as they cope with situation; Parent/s may develop and enforce rules to reduce the risk of sibs being victimized, causing resentment and rebellion; Need to be included in any treatment plan.

Information Gathering: Perpetrator Law enforcement involvement; Who, where, what are you interviewing for? Denial 1st response Minimization of behaviors Justification Blame onto victim or spouse “Sick and sympathy”

Welcome Back! Questions, Comments, Clarifications… Day Two Welcome Back! Questions, Comments, Clarifications…

Assessment Physical and Behavioral Indicators Child’s Disclosure Evidence Discovery Collateral Information Child/ Family/ Perpetrator History Alternative Hypotheses/ Confirmatory Bias Source Monitoring Perpetrator Admission or Confession

Cultural Considerations What is the general cultural perception of the act/s? How best to structure approach to child and family Relationship with authority/government entities Shame for the child, parent/s, community Language proficiency, taboo topics or words

Analyzing the Child’s Statement Multiple events/elements of progression; Explicit sexual knowledge Richness of details/idiosyncratic details Internal logic/feasibility Secrecy Presence of pressure, coercion, enticement Child’s perspective of events*

Alternative Hypotheses Reasonable alternative explanations for what the child is describing or other elements uncovered through the investigative process.

Validation of the Referral Looking at the totality of the information gathered from all sources, does it: Fit professional knowledge of dynamics of child sexual abuse? Is there a secondary gain for one of the principals? Is there medical validation/ support? Is there physical evidence to support allegation? Is there prior history?

The Impact of Sexual Abuse One child’s voice

Information Gathering: Child Victims (also refers to section on Impact of Abuse) Guilt “Damaged Goods” belief Blurred physical boundaries Sexualized behaviors Ability to say “NO” Difficulty in talking about ‘taboo’ material Embarrassment, shame, anger, fear Location of interview Degree of privacy Rapport with interviewer Previous decision to disclose Questioning style of the interviewer Presence of a witness (supportive or otherwise) Response of other adults to previous disclosures of maltreatment

Case Management Considerations Separating the Family Perpetrator from family Child/children from family Collaboration and Monitoring Multidisciplinary team functioning Developing and monitoring treatment plan/s Visitation/ Reunification If, when, and how

Treatment Considerations for Victims Treatment Approaches Supportive Symptom-focused Abuse focused Visit this website for Evidence Based Practice: http://www.cachildwelfareclearinghouse.org Treatment Issues Foster healthy expression of feelings related to abuse Reframe/correct distorted thinking about the abuse Assist the child in understanding nature and impact of abuse Reduce behavioral symptoms and emotional distress Sex education; assertiveness; self-esteem; empowerment; personal safety

Treatment Issues for the NOP Treatment Approaches Supportive Psychoeducational Abuse-focused Treatment Issues Enhance Safety/Reduce Risk! Believe abuse occurred Hold perpetrator responsible Empathy/ support for child Identification of their own role in abuse Resolution of own abuse/victimization issues Foster independence

Treatment Issues for Perpetrator Treatment Approaches Cognitive Behavioral Relapse prevention Offense-specific Treatment Issues Accept responsibility for behaviors Develop/demonstrate empathy for victims and others Modification of thinking errors/cognitive distortions Identify and reduce/control deviant sexual arousal Resolution of own childhood abuse/victimization

Time to see what you have learned so far! Embedded Evaluation Time to see what you have learned so far!

Closure THANK YOU AND GOOD LUCK TO YOU IN YOUR CHILD WELFARE WORK WITH CHILDREN AND THEIR FAMILIES.